Abstract

The prevalence of kidney stones is rising rapidly in the United States. Data from the Urologic Diseases in America project suggests that healthcare utilization and expenditures for treating patients with kidney stones are rising dramatically as well. Current understanding of treatment patterns is limited, but suggests that urologists are moving away from shock-wave lithotripsy and towards ureteroscopy for urinary stones that require intervention. Many opportunities exist for furthering our understanding of healthcare delivery for stones, including assessing quality of care, drivers of expenditures, and opportunities to maximize value for patients.

Comments
1

This article is a summary of the management of patients with urolithiasis in USA. There are some points that deserve attention. In the emergency setting CT has become the dominating imaging modality. This technique results in more detailed information but gives a higher x-ray load. This routine has apparently been accepted worldwide in a short period of time.

For stone removal SWL and URS were the procedures used in more than 95% of the patients. Thereby it is of note that URS was increasingly common compared with SWL (7.6/1000 vs 7.2/1000). It is likely that the higher re-treatment rate for SWL plays an important role in this development (38% vs. 10%). Noteworthy is, however, that there also was a substantial need of re-treatments following URS. It can be assumed that improved skill in SWL can reduce the frequency of re-.treatments with SWL.

It is not mentioned in the article to which extent economic factors might have contributed to the choice of stone removing procedure.

This article is a summary of the management of patients with urolithiasis in USA. There are some points that deserve attention. In the emergency setting CT has become the dominating imaging modality. This technique results in more detailed information but gives a higher x-ray load. This routine has apparently been accepted worldwide in a short period of time.
For stone removal SWL and URS were the procedures used in more than 95% of the patients. Thereby it is of note that URS was increasingly common compared with SWL (7.6/1000 vs 7.2/1000). It is likely that the higher re-treatment rate for SWL plays an important role in this development (38% vs. 10%). Noteworthy is, however, that there also was a substantial need of re-treatments following URS. It can be assumed that improved skill in SWL can reduce the frequency of re-.treatments with SWL.
It is not mentioned in the article to which extent economic factors might have contributed to the choice of stone removing procedure.
Hans-Göran Tiselius